Reading of the Week: Do Patients with Cancer Struggle with PTSD? Yes – the new Cancer Paper. Also, Quebec Covers Therapy

From the Editor

I spent a dozen years working at a community hospital. One of my richest experiences was working with cancer patients and their families. For so many patients, not surprisingly, cancer isn’t just a physical illness, but a psychiatric one, too – patients often experience depression and anxiety.

How common is PTSD in cancer patients? Surprisingly little work has been done in the area. In this week’s Reading, we look at a new study that considers PTSD and cancer. The study is particularly impressive in that patients were followed for years after diagnosis.

Big diagnosis, big treatment, big psychiatric problems?

In this Reading, we consider the paper and its findings.

And, with an eye on treatment for those with or without cancer, we consider a good news story: on Sunday, the Quebec government committed itself to cover psychotherapy for those with depression and anxiety in the public system.

DG

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Reading of the Week: Is AVATAR Therapy a Breakthrough for Those Who Hear Voices? The New Lancet Psychiatry Paper

From the Editor

“The voices won’t leave me alone.”

A patient made this comment to me recently. And it’s an experience many patients have had. Despite medications and follow up, the voices continue to be problematic.

This week, we look at a new paper from The Lancet Psychiatry which considers a novel approach: AVATAR therapy.

In this study, patients who experienced auditory hallucinations created a computerized simulation (avatar) of the voice they most wanted to influence, including what the voice said, how it sounded, and how the “entity” with the voice looked like. Patients, working with a therapist who controlled the avatar, then had therapy sessions in which they could talk to it. Patients were compared on several measures to those who only received supportive therapy.

The paper has received significant media attention including CNN and BBC.

1124avatar2The Face of the Voice – and a Step Toward Healing?

Spoiler alert: the therapy helped – at least initially – but the results are complicated. (And, no, this isn’t “fake news,” to borrow a phrase from an American politician.)

In this Reading, we consider the paper and its findings.

DG

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Reading of the Week: The Pill That Talks to Doctors, & More

From the Editor

The pill. The criticism. The question.

Readings have covered everything from new books to political speeches. This week, we consider a few thought-provoking pieces. Is there a common theme? Maybe this: the world of mental health care is changing – and fast.

In these three selections, we look at: the pill that talks to doctors and family, the criticism of digital health, the question about the true nature of schizophrenia.

Enjoy.

DG

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Reading of the Week: Better Sleep, Less Psychosis? The Freeman et al. Study on Sleep & CBT

From the Editor

If students sleep better, are they less likely to have mental health problems like paranoia?

In this week’s Reading, we look at a new study from The Lancet Psychiatry. In this single-blind, randomized controlled trial, Oxford professor Daniel Freeman et al. consider students from 26 universities with insomnia, assigning them CBT (offered over the internet) or the usual care.

Spoiler alert: the students with CBT did better.

Sleep: good for babies, teddy bears, and students

In this Reading, we review that paper and consider the broader implications.

DG

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Reading of the Week: ECT – Safe, Effective but Declining Use. The Lemasson et al. Study on ECT in Quebec

From the Editor

It’s an effective treatment for depression – maybe the most effective. Yet ECT remains highly controversial. Patients routinely ask about its safety; the media portrayal is tough.

This week, we look at two new studies on electroconvulsive therapy. In the first, just published in The Canadian Journal of Psychiatry, the authors consider the use of ECT in Quebec over a 15-year period, finding a decline over time.

An ECT Machine: going the way of the dodo bird?

We also look at a new paper from Acta Psychiatrica Scandinavica considering the safety of ECT, tapping a rich database.

These new papers point to a public health problem: the treatment is incredibly safe (and effective) but used less and less often.

Note: there will be no Reading next week.

DG

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Reading of the Week: Are the Kids Alright? NYT on Severe Anxiety & Adolescents

From the Editor

“The disintegration of Jake’s life took him by surprise.”

This quotation is from a long, moving essay about a young patient with a big problem. The piece begins with Jake in his junior year of high school with much on his plate: three Advanced Placement courses, a spot on the cross-country team, invitations to Model U.N. conferences – and significant anxiety.

The essay explores his anxiety, and the anxiety of teens like Jake.

The essay, which recently ran in The New York Times Magazine, traces the struggles of Jake, and the writer puts these problems in a larger context.

Teen anxiety: A growing problem?

In this Reading, we review this essay.

DG

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Reading of the Week: Depression, Pills & Adherence – the Sirey et al. Study on Improving Depression Treatment

From the Editor

The patient is depressed. The doctor has prescribed medications. But the patient doesn’t take them.

As a clinician, this scenario is too familiar with results that are too familiar – the patient doesn’t get better. What can we do to improve adherence?

In this week’s selection, we look at a new paper by Weil Cornell Medicine’s Jo Anne Sirey et al., considering this question. The authors do a randomized controlled trial with “a brief psychosocial intervention designed to improve adherence to pharmacotherapy for patients with depression.” So, is this intervention a game-changer? The authors find a five-fold increase in adherence during the first 6 weeks of care – but not much change in overall depressive symptoms.

153745515Pretty pill bottle: But how can we get patients to take the pills?

In this Reading, we review the paper.

DG

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Canadian Journal of Psychiatry: “Telepsychiatry 2.0”

‘Closed-circuit television has been introduced into the field of mental hygiene as a medium for the administration of therapy to a mass audience. The present evidence indicates that that the use of this type of television may promote the development of new and more effective methods for the treatment of the mentally ill.’ This hopeful statement appeared at the beginning of a 1957 peer-reviewed paper. Four years later, the potential of telepsychiatry ‘as a means of extending mental health services to areas that are remote from psychiatric centers’ was described. Six decades later, where are we?

So begins an editorial in the current issue of The Canadian Journal of Psychiatry.  I’ve co-authored the paper; Dr. David Goldbloom is the first author.

cpab_62_10-cover

Drawing on the Serhal et al. paper on telepsychiatry in Ontario, we consider the current state:

Consider: of the more than 48,000 people in need of psychiatric care (defined by the authors as psychiatric or primary care within a year after a psychiatric hospitalisation), fewer than 1% saw a psychiatrist through telepsychiatry—and 39% saw no psychiatrist. We note the marked contrast with the United States, where telepsychiatry has been rapidly growing.

And we consider how to move forward. We propose a four-point plan, including “a province-wide strategy that has defined clinical priorities, geographic rationales, and measured outcomes.”

You can find our editorial here:

http://journals.sagepub.com/doi/full/10.1177/0706743717714469

Note: open access.

Reading of the Week: “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy?” JAMA on Psychotherapy

From the Editor

Is CBT overrated? The authors of a new JAMA paper raise this question in a cutting Viewpoint.

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

Last week, we looked at conversational agents.

This week, we ask: is CBT really the gold standard for psychotherapy?

University of Giessen’s Falk Leichsenring and Medical School Berlin’s Christiane Steinert consider CBT and the research that has been done in the area. “CBT is usually considered the gold standard for the psychotherapeutic treatment of many or even most mental disorders.” But should it be? Leichsenring and Steinert argue no.

beck_aaron_t-_112798Aaron Beck: Great bowtie, but is his CBT really so great?

In this Reading, we review their paper, and consider their argument.

DG

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Reading of the Week: “Talking to Machines About Personal Mental Health Problems.” JAMA on Therapy & AI

From the Editor

Will people seek therapy with computers one day, getting care from programs built with Artificial Intelligence?

The authors of a new JAMA paper consider this in a short, clever piece, titled “Talking to Machines About Personal Mental Health Problems.”

In this two-part Reading of the Week series, we look at two papers, both published in JAMA. These Viewpoint pieces make interesting, provocative arguments.

This week, we look at conversational agents.

Next week, we ask: is CBT really the gold standard for psychotherapy?

Stanford University’s Adam S. Miner and his co-authors consider conversational agents – that is software programs that “use conversational artificial intelligence to interact with users through voice or text.” Could there be therapeutic value in such a program? What are the ethical challenges?

Robot and human hands almost touching - 3D render. A modern take on the famous Michelangelo painting in the Sistine Chapel; titled, "The Creation of Adam".

In this Reading, we review the paper, and consider the potential of conversational agents, with an eye on what’s currently available.

DG

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